Category: Communication challenges

Working in a specialty that is almost overwhelmed by '2 week wait' referrals (patients who are sent by their GPs with a suspicion of cancer), I am often asked, 'How long?' For some patients, inevitably, are found to have incurable disease. It is the job of me and my colleagues to provide an answer. Frequently,... Continue Reading →

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It was time. After a week in hospital Mrs G, in her late 80’s, had failed to improve from a chest infection. Her frailty meant that the chances of making it out of hospital were shrinking. We were duty bound to discuss resuscitation. I knew what I thought: there was no way it would work.... Continue Reading →

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A recent thread on Twitter brought up a subject that is really spoken about. Elin Roddy kicked it off with a comment that patients admitted to nursing homes should routinely be engaged in conversation about their preferences towards end of life. With habitual frankness, she later commented that there is a danger that those... Continue Reading →

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'Through rose tinted spectacles', by monstercoach This time I was going to give the hard news. That was my agenda. He had been in out of hospital a few times, his cognitive and physical status fluctuating due to the underlying condition. There was no cure. So in they came to the clinic, husband and... Continue Reading →

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M.C. Escher - Hand with reflecting sphere It's a common enough feeling but one that is rarely expressed. This patient did express it - or at least her husband did for her. The patient had undergone multiple investigations and several procedures during three stays in hospital. Her GP had referred her for a review... Continue Reading →

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The judgment given in the case of Janet Tracey’s estate vs Cambridge University Hospital NHS Foundation Trust* contains lessons and warnings for doctors and nurses. There are fundamental implications, and there are subtle insights into how we go about discussing DNACPR decisions. The judge wrote, in conclusion: I would, therefore, grant a declaration against... Continue Reading →

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Welcome to the first interactive medical ethics adventure on the Illusions of Autonomy blog. You will guide an experienced trainee doctor, Nina Charan, through a difficult but not uncommon scenario, and in exploring the consequences of various decisions will experience the risks and pitfalls that are encountered on medical wards. It may end after just... Continue Reading →

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Detail from cover of 'The Picture of Dorian Gray' by Oscar Wilde When I tell him that his liver is so badly diseased it may not recover, he turns away and looks into the middle distance. There are no questions. He was expecting this. He has probably known that it would end like this for several... Continue Reading →

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The report ‘Building a culture of candour - A review of the threshold for the duty of candour and of the incentives for care organisations to be candid’ makes very interesting reading. It seeks to define levels of harm that should trigger an approach to patients and relatives, and explores how organisations can be encouraged... Continue Reading →